People still have sex during outbreaks — forgetting it can be deadly

Planning for the pandemic has to include sexual and reproductive health services. If not, we risk saving women from the new coronavirus but leaving them to die during childbirth, unsafe abortionsor at the hands of their partners.

COMMENT

The world is gearing up its response to the
rapidly spreading new coronavirus, SARS-Cov-2. But as it does so, access to
sexual and reproductive health services and care are being severely curtailed.

In 1994, the groundbreaking International Conference on Population and Development (ICPD) in Cairo produced a paradigm-shifting ICPD Programme of Action. The document committed more than 180 countries to ensure comprehensive sexual and reproductive health care for everyone. It also recognised that sexual and reproductive health and women’s empowerment are intertwined and that both are necessary for the advancement of society.

More than 25 years later, a third of women now use a modern contraceptive method compared to less than one in 10 in 1994, shows the United Nations Population Fund’s (UNFPA) 2019 global report. Similarly, a woman’s risk of dying due to complications of pregnancy or childbirth has dropped from a 1-in-20 chance in her lifetime to 1-in-55.

During Ebola, a lack of access to healthcare, including sexual and reproductive health services, killed nearly as many as the virus

But today, the promise of the ICPD Programme
of Action is yet to be fully realised for millions of people in East and
Southern Africa where UNFPA data tells us that the likelihood of a woman dying
due to pregnancy or childbirth is twice the global average. Almost one in six
young women will experience gender-based violence, says a 2013 World Health
Organisation report.

Nearly all new HIV infections globally are now
occurring in just 15 countries, mostly from the East and Southern Africa
region, UNAids data shows.

And if sexual and reproductive health services are not embedded now as part of national and local responses to the new coronavirus, in the coming months we are likely to see a rise in sexually transmitted infections and unintended pregnancies, including high-risk teen pregnancies — as was reported by at least one district in Sierra Leone during the 2014 Ebola outbreak, according to research published in 2015 in the Journal of Public Health.

Watch: Tales of love and loss from post-Ebola Sierra Leone

As unintended pregnancies rise, so too may
unsafe abortions. Meanwhile, the more women who give birth, the more women and
babies stand the chance of dying due to lack of access to critical care and
safe childbirth services.

But during Sierra Leone’s recent Ebola outbreak, disruptions in essential sexual and reproductive health services and changes in health-seeking behaviour killed nearly as many people as the disease itself, 2016 research published in the journal of Health Policy and Planning showed.

Five ways to put women at the centre of the response to the coronavirus outbreak

But we can stop this, which is why we are
making an urgent appeal to all countries to think about these five ideas as
they plan their responses:

While dealing with the pandemic, ensure continued access to quality essential and integrated sexual and reproductive health services, including modern contraceptives, as well as the prevention and treatment of HIV and other sexually transmitted infections. Be alert to evidence of sexual and gender-based violence, and other harmful practices;

Collect accurate and complete age and sex-disaggregated data to understand how COVID-19 impacts different segments of the population;

Identify ways to ensure minimum disruption to the provision of comprehensive sexuality education, counselling and services for infertility, prevention and management of reproductive cancers, and sexual health — including menstrual health.

We urge our partners to fully consider the advice and guidelines from the World Health Organisation, United Nations Population Fund and broader United Nations system as they develop and implement COVID-19 preparedness and response plans.

Any backward trend in access to sexual and reproductive healthcare services will not only devastate the lives of millions of women and girls but also slow down the progress towards the Sustainable Development Goals, which are crucial for creating a more equal, prosperous and sustainable world.

We stand ready to support countries against
the pandemic. If we take action now, we can minimise human suffering
later.